甲状腺乳头状癌超声图像特征及BRAF V600E突变与颈部淋巴结转移的关系

Correlation of ultrasonographic characteristics,BRAF V600E gene mutation and cervical lymph node metastasis in papillary thyroid carcinoma

目的分析甲状腺乳头状癌(PTC)超声图像特征及BRAF V600E突变与颈部淋巴结转移的关系。方法选取于我院行甲状腺癌根治术患者316例,根据甲状腺癌术后病理分期(pTNM)结果,将pN0(无颈部淋巴结转移)者归为未转移组(160例),pN1(有颈部淋巴结转移)者归为转移组(156例),比较两组超声图像特征、临床资料、BRAF V600E突变情况的差异。采用多因素Logistic回归分析PTC超声图像特征、BRAF V600E突变及各临床资料与颈部淋巴结转移的关系。结果转移组98例(62.8%)发生BRAF V600E突变,未转移组121例(75.6%)发生BRAF V600E突变,两组BRAF V600E突变占比比较,差异有统计学意义(P<0.05)。转移组与未转移组年龄及病灶数目、大小、沙粒样钙化、纵横比、边缘、与被膜关系、累及腺叶比较,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,病灶大小、纵横比、与被膜关系、累及腺叶均为颈部淋巴结转移的危险因素(OR=3.606、4.061、2.149、8.578,均P<0.05),年龄、沙粒样钙化、病灶边缘均为颈部淋巴结转移的保护因素(OR=0.364、0.389、0.409,均P<0.05)。结论PTC颈部淋巴结转移与年龄及病灶大小、沙粒样钙化、纵横比、边缘、与被膜关系、累及腺叶均有关,与性别、病灶数目、BRAF V600E突变无关。

Objective To analyze the correlation of ultrasonographic characteristics,BRAF V600E gene mutation and cervical lymph node metastasis in papillary thyroid carcinoma(PTC).Methods Three hundred and sixteen patients with thyroid cancer underwent radical thyroidectomy in our hospital were selected.According to the pathological stage(pTNM)of thyroid cancer after surgery,the patients with pN0(without cervical lymph node metastasis)were classified as the non metastasis group(n=160),and patients with pN1(with cervical lymph node metastasis)were classified as the metastasis group(n=156).The differences of ultrasonographic characteristics,clinical data and BRAF V600E mutation between the two groups were compared.Multivariate Logistic regression analysis was used to analyze the relationship between PTC ultrasonographic characteristics,BRAF V600E mutation and cervical lymph node metastasis.Results Totally 98 cases(62.8%)in metastasis group developed BRAF V600E mutation,while 121 cases(75.6%)in non metastasis group,and the proportion of BRAF V600E mutations between two groups was statistically significant(P<0.05).There were statistically significant differences in terms of age,number and size of lesions,sand calcification,aspect ratio,lesion margin,the relationship between lesions and membrane,and involvement of glandular lobes between the metastasis group and the non metastasis group(all P<0.05).Multivariate Logistic regression analysis showed that lesion size,aspect ratio,the relationship between lesion and membrane,and the involvement of glandular lobes were risk factors for cervical lymph node metastasis(OR=3.606,4.061,2.149,8.578,all P<0.05),while age,sand-like calcification and lesion margin were protective factors for cervical lymph node metastasis(OR=0.364,0.389,0.409,all P<0.05).Conclusion The cervical lymph node metastasis of PTC is related to the patient’s age,lesion size,sand-like calcification,aspect ratio,the relationship between the lesion and membrane,and involvement of glandular lobe,but not related to gender,number of lesions,and BRAF V600E mutation.